Quantification of intra-articular fibrosis in patients with stiff knee arthroplasties using metal-reduction MRI.
Quantification of intra-articular fibrosis in patients with stiff knee arthroplasties using metal-reduction MRI.
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DOI：
10.1302/0301-620x.102b10.bjj-2020-0841.r1
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发表时间：
2020-10
期刊：
影响因子：
--
通讯作者：
Kalson NS
中科院分区：
文献类型：
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作者：
Attard V;Li CY;Self A;Mann DA;Borthwick LA;O'Connor P;Deehan DJ;Kalson NS
僵硬是全膝关节置换术（TKA）后常见的并发症。发病机制尚不清楚，治疗选择有限，诊断也具有挑战性。本研究的目的是调查 MRI 是否可用于观察僵硬、疼痛的膝关节置换术患者的关节内疤痕。功能良好的初次 TKA (n = 11)、失败的非纤维化 TKA (n = 5) 和临床诊断为纤维化的患者 (n = 8) 接受了带有钆对比的高级金属抑制（用于金属伪影校正的切片编码，SEMAC）的 MRI 扫描。纤维化组织（T1 和 T2 上的低强度，低中度对比后增强）在六个隔室中进行量化（存在和组织厚度）：上/下髌骨、内侧/外侧沟槽和后内侧/外侧。在所有研究的患者中均发现了纤维化组织。然而，与非纤维化患者 (2.5 mm ± 0.4 mm) 和正常 TKA (1.9 mm ± 0.2 mm，p = < 0.05) 相比，纤维化患者的组织明显更厚 (4.4 mm ± 0.2 mm)。在纤维化组中，26/48 (54%) 的检查区室中可见显着（> 4 mm 厚）组织，相比之下，非纤维化组为 17/30 (57%)，正常 TKA 为 10/66 (15%)。尽管翻修手术确实改善了所有纤维化患者的活动范围（ROM），但手术后仍然存在临床上显着的限制。僵硬的 TKA 含有可通过 MRI 识别的关节内纤维化组织。研究应评估 MRI 是否有助于清创手术计划，以及作为纤维化引起的僵硬干预后的非侵入性测量工具。修正硬度可以改善活动度，但结果并不理想，需要新的治疗方法。引用这篇文章：Bone Joint J 2020;102-B(10):1331–1340。
Stiffness is a common complication after total knee arthroplasty (TKA). Pathogenesis is not understood, treatment options are limited, and diagnosis is challenging. The aim of this study was to investigate if MRI can be used to visualize intra-articular scarring in patients with stiff, painful knee arthroplasties. Well-functioning primary TKAs (n = 11), failed non-fibrotic TKAs (n = 5), and patients with a clinical diagnosis of fibrosis (n = 8) underwent an MRI scan with advanced metal suppression (Slice Encoding for Metal Artefact Correction, SEMAC) with gadolinium contrast. Fibrotic tissue (low intensity on T1 and T2, low-moderate post-contrast enhancement) was quantified (presence and tissue thickness) in six compartments: supra/infrapatella, medial/lateral gutters, and posterior medial/lateral. Fibrotic tissue was identified in all patients studied. However, tissue was significantly thicker in fibrotic patients (4.4 mm ± 0.2 mm) versus non-fibrotic (2.5 mm ± 0.4 mm) and normal TKAs (1.9 mm ± 0.2 mm, p = < 0.05). Significant (> 4 mm thick) tissue was seen in 26/48 (54%) of compartments examined in the fibrotic group, compared with 17/30 (57%) non-fibrotic, and 10/66 (15%) normal TKAs. Although revision surgery did improve range of movement (ROM) in all fibrotic patients, clinically significant restriction remained post-surgery. Stiff TKAs contain intra-articular fibrotic tissue that is identifiable by MRI. Studies should evaluate whether MRI is useful for surgical planning of debridement, and as a non-invasive measurement tool following interventions for stiffness caused by fibrosis. Revision for stiffness can improve ROM, but outcomes are sub-optimal and new treatments are required. Cite this article: Bone Joint J 2020;102-B(10):1331–1340.